Surplus labour
The origins of professions — Alienation — Wage slavery — How does capitalism dominate Western healthcare? — Controlling systems — Professional projects — The conquest of official privilege — Implications for physiotherapy — Are individual physiotherapists responsible? — Critiques of Marxian approaches to the professions
In the last chapter, we set the foundations for the sociological study of physiotherapy, focusing on functionalism, and its belief in the stabilising role professions played in society. Functionalism came at a time when Western societies were in upheaval, and it fed into peoples’ hope that human society was ultimately progressing and becoming balanced, ordered, and peaceful. It also appealed greatly to the new professional middle class of teachers, engineers, lawyers, scientists, journalists, architects, doctors, nurses, and physiotherapists, that had begun to emerge. It told them that their work was socially significant, and that they represented the best of us.
But functionalism had many critics too, and these became increasingly vocal after World War II. Critics argued that functionalism told us nothing about the reasons why power was so unevenly distributed in society. It said nothing about the professionals’ practices of self-interested social closure. It viewed any critique as upsetting the balancing effect of professions in society. And it saw people as passive subjects of social order, rather than active agents shaping the world around them.
There have been dozens of social theorists offering alternatives to functionalism over the last century. But all of them, at some level, owe a debt to the ideas explored in this chapter. The chapter deals with the legacy of Karl Marx (1818-1883), and the Marxian critique of the professions that began in earnest in the 1950s. Marx’s work, especially The Communist Manifesto [1] and Das Kapital (translated simply as ‘Capital’) [2], were produced together with Friedrich Engels (1820-1895) who, together, provided some of the most important works of social history ever produced.
Although Marx and Engels’ writings came in the 19th century, before today’s health professions had been conceived, their work provided the groundwork for much of the sociology of the professions that followed. In fact, it would be no exaggeration to say that it would be impossible to understand what the professions are today, without a reasonable understanding of Marxian theory. Marx and Engels gave birth to ‘conflict theory’ and the idea that societies were based on disputes and competition, rather than the consensus of functionalism. But their focus on the nature of work and labour also holds special significance for our analysis of physiotherapy, and so sets up much of what follows in the subsequent seven chapters.
As well as redefining the study of economics, Marx and Engels were consummate historians and sociologists. Their writings redefined how we understood the history of Western society; the relationships between social institutions like ‘the state’, and individual human agency; the psychology of modern life; and the role concepts like work and surplus value play in shaping capitalism and market economies. Perhaps we should begin, then, with the way Marxian theorists explain how professionals appeared in the first place.
